I agree that Coloplast A/S and its affiliates (“Coloplast”) and their third party service providers may collect, use, transfer and process personal and health information about me for the following purposes (“Purposes”):

1.

To provide support, guidance, and information about the proper use of Coloplast products;

2.

To interact with my healthcare provider, healthcare facility or supplier of product, for prescription verification as necessary;

3.

To conduct consumer and marketing related research and analysis;

4.

To provide marketing and educational information related to Coloplast products and services;

5.

To process sample requests; and

6.

To perform other administrative tasks or to comply with applicable law.

I agree that Coloplast may contact me by phone (including my cell phone if that is the number I provided), text message (sms), e-mail, hard copy letter, or other means of communication but only for the Purposes referred to above. I further understand that I must designate a phone number where I may be reached if I want to be contacted by phone. By designating a phone number and agreeing to the Confirmation of Consent, I provide my consent to receive calls, text messages and/or pre-recorded or artificial voice messages at that number from Coloplast, sent by automated technology. I understand that consent is not necessary to do business with Coloplast and that I can opt out of communications from Coloplast at any time.

I understand that I can unsubscribe at any time if I do not want to receive communication from Coloplast other than to receive product samples. I understand that if I do not agree to the Coloplast Confirmation of Consent I need to call Coloplast at 1-888-726-7872 to request my product samples.